Medical society pushes for more N.B. training spots for emergency doctors

More emergency doctors must be trained in New Brunswick to keep ERs in the province going, says the New Brunswick Medical Society.

Health Minister Dorothy Shephard's plan for reinvigorating the health-care system acknowledges the problem that has troubled the province for years — a shortage of staff — but details have been missing about how recruitment efforts will change.

The plan released last month also mentions using "innovative education and training models" to address the shortage, but offers little in the way of concrete steps.

But the medical society has identified at least one move it believes is part of the solution: create more residency positions in emergency medicine.

"Recruiting and retaining the appropriate number of emergency physicians in the province is crucial to keep our ERs functioning," Dr. Mark MacMillan, the president of the medical society, said in an interview. 

"The society has always been in favour of enhancing medical learning in the province, because we know if you train here, you're more likely to stay here and work here in the future."

Currently, New Brunswick has two residency positions open each year to medical school graduates seeking certification in emergency medicine through the Dalhousie University program in Saint John.

The medical society wants to see an expansion of a three-year program that leads to certification from the College of Family Physicians of Canada, a step that could help emergency departments in less urban areas.

This year nurse and doctor shortages, underscored by the COVID-19 pandemic, have forced Horizon Health to reduce the hours of some emergency departments. Reduced service continues at the Sackville Memorial and Oromocto Public hospitals.

Not enough ER doctors prompted Oromocto cuts 

Internal emails among senior management at Horizon Health, obtained through right-to-information requests, indicate a shortage of emergency room physicians in the Fredericton area led to the reduced ER hours at Oromocto Public Hospital in the summer.  

Starting June 22, the Oromocto ER began closing at 4 p.m., instead of 10 p.m. because doctors were needed to keep the ER going at Dr. Everett Chalmers Regional Hospital in Fredericton, according to emails from Dr. Édouard Hendriks, the former vice-president of medical, academic and research affairs at Horizon.

The Oromocto ER was transformed into an "urgent care centre" in the meantime, since only family physicians were available to work there and weren't qualified to handle patients needing emergency care,  Hendriks' correspondence from June 15 shows. 

Hendriks did not respond to an interview request from the CBC News.

Emails sent from family physicians in response to senior management emphasized several concerns about their ability and willingness to staff the emergency room. 

"Family practitioners working in the community often no longer possess the skill set to manage traumas, MIs, fractures, chest tubes and intubations," Fredericton doctor Kari Van Middlesworth wrote to Hendriks. 

"It is not safe for patients and patients won't triage themselves correctly. When patients attend an ER they are often inaccurate in judging the severity of their problem." 

Medical society wants to raise standards in ERs 

The medical society's call for more residency positions follows advice from the section of the society representing emergency physicians.

"We believe that we have the need and the capacity to increase residency training capabilities here in New Brunswick, which we believe will help us fill our emergency department positions with trained emergency physicians, and raise the standard of emergency medicine across the province," the section leaders said in a statement to CBC News.

The medical society also wants Horizon and Vitalité to promote more collaboration between rural and regional hospitals, since many emergency rooms don't have any physicians certified in emergency medicine. 

According to the online registry of physicians, most emergency physicians practising at New Brunswick hospitals are found in Moncton's two hospitals, the Saint John Regional Hospital, and the Chalmers Hospital in Fredericton.

In total, there are 71 physicians with a certification in emergency medicine in the province, including three with temporary licences. More than half are listed as working in the Saint John region. 

The numbers posted in the online registry may not be 100 per cent accurate, said Dr Alaa Al -Sharief, the emergency department head at the Upper River Valley Hospital. He said physicians sometimes move to other hospitals before the changes can be posted online. 

The medical society also wants regional health authorities to move toward requiring this type of certification when making new hires in emergency rooms, especially when it comes to hospitals in urban hubs. 

"Requiring this type of certification might cause some challenges for certain departments who are struggling to recruit their open positions," said Anthony Knight, the CEO of the medical society. "But the long-term goal of enabling and establishing that criteria would have a benefit to these departments going forward."

The integrated family and emergency medicine program in Saint John helps staff ERs all around the province, and residents often work at rural hospitals such as the Sussex Health Centre, the Charlotte County Hospital, and the Upper River Valley Hospital in Waterville, said Dr. Rob Dunfield, a third-year resident in Saint John.

"We're in our training, but we play an important role in taking care of patients," Dunfield said. "We've had less of an issue around staffing positions at these hospitals in the emergency departments thanks to this program."

Opening up more training opportunities for medical residents would require collaboration among medical schools, hospitals and the medical colleges that provide the certification, as well as funding commitments from the province, MacMillan said. 

Shepard hasn't made any commitments to increase the number of training opportunities in medicine.

"We are in frequent talks to try and understand how we can improve the number of students that we have, what is possible, and we're certainly going to continue to have those discussions," she told reporters after announcing her health-care plan.

The Health Department has also been in discussions with medical schools about how training can be shortened, and is looking into recognizing medical certifications from other countries, Shepard said.

It's not uncommon for New Brunswick's medical graduates to pursue residencies in another province. This year, more than 60 per cent of medical graduates left to complete residencies elsewhere, according to the province.